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Published on: March 14, 2017
Paediatric immunisation and chemoprophylaxis in a Ugandan sickle cell disease clinic
Chung-Jen Chen1, Sabrina Bakeera-Kitaka2, Ezekiel Mupere2
1Department of Pediatrics, Columbia University Medical Center, New York, New York, United States.
Insights
Recommended vaccinations and preventative medications for children with sickle cell disease (SCD) in Uganda were often incomplete and delayed. Improved clinic oversight is needed to ensure timely uptake of essential care for SCD patients.
Area of Science:
- Pediatrics
- Hematology
- Public Health
Background:
- Sickle cell disease (SCD) requires comprehensive care, including vaccinations and prophylactic medications, to prevent serious complications in young children.
- Assessing the quality of care for SCD patients in resource-limited settings is crucial for identifying gaps and improving health outcomes.
Purpose of the Study:
- To evaluate the receipt of recommended vaccinations and prophylactic treatments for children under 71 months with SCD at a central clinic in Kampala, Uganda.
- To identify factors associated with the timely and complete administration of these essential preventative measures.
Main Methods:
- A cross-sectional study was conducted at Mulago Hospital SCD Clinic, reviewing immunization cards and clinic records.
- Data on vaccination status, timeliness, and prescribed antibacterial and antimalarial prophylaxis were collected for children with SCD aged ≤71 months.
Main Results:
- Only 46.2% of children received all recommended vaccine doses, with lower completion rates for pneumococcal 10-valent conjugate vaccine (PCV-10) in older children (18.2% for ages 48-71 months).
- Timely vaccination (<60 days late) was achieved in only 68.8% of fully vaccinated children, with just 13.5% being both fully and timely vaccinated.
- While 81.6% had documented prescriptions for penicillin and/or antimalarial prophylaxis, adherence and completeness were not detailed.
Conclusions:
- Preventative care, including vaccinations (especially PCV-10) and chemoprophylaxis, was incomplete and often delayed for young children with SCD at this Ugandan clinic.
- Child age was associated with vaccination and chemoprophylaxis receipt, but not general maternal demographics.
- Enhanced clinic-based oversight is recommended to improve the timely uptake of these critical preventative health measures for children with SCD.
Aim:
We aimed to assess the receipt of recommended care for young children with sickle cell disease (SCD) in a central SCD clinic in Kampala Uganda, focusing on standard vaccination and antibacterial and antimalarial prophylaxis.
Methods:
A cross-sectional assessment of immunisation status and timeliness and prescribed antibacterial and antimalarial prophylaxis was performed in a sample with SCD aged ≤71 months in Mulago Hospital SCD Clinic. Government-issued immunisation cards and clinic-issued visit records for prescribed prophylaxis were reviewed.
Results:
Vaccinations were documented by immunisation cards in 104 patients, mean age 31.7 months (range 3-70 months). Only 48 (46.2%) received all doses of each of the four recommended vaccine types, including pneumococcal 10-valent conjugate vaccine (pneumococcal conjugate vaccine (PCV)-10), which became available in 2014. Vaccination completion was associated with younger age and, for polio, maternal employment. PCV-10 series was completed in 54.8% of the sample and in 18.2% of those aged 48-71 months. Of children completing all vaccination types, an average 68.8% were immunised on time, defined as <60 days beyond the recommended age. Only 17 (13.5%) children were both fully and timely vaccinated. In an overlapping sample of 147 children, with a mean age of 38.4 months (4-70 months), 81.6% had ≥1 documented prescription for penicillin and/or antimalarial prophylaxis.
Conclusions:
Standardised vaccination and antibacterial and antimalarial protective measures for young children at this central SCD clinic were incomplete, especially PCV-10 for age ≥24 months, and often late. Child age, but not general maternal demographics, were associated with vaccination and chemoprophylaxis. Clinic-based oversight may improve timely uptake of these preventative measures.
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